Background: Indonesia has one of the highest smoking rates globally. Smoking cessation is critical for reducing smoking-related diseases, particularly in areas with limited healthcare access. This study explored factors associated with smoking cessation in underdeveloped areas of Indonesia.Study Design: This study was conducted using a cross-sectional design.Methods: Data were obtained from the 2018 Indonesia Basic Health Research survey. We used information from 16,989 ever-smokers aged 10 years or older living in underdeveloped areas of Indonesia. Binary logistic regression analyses were performed to identify factors associated with smoking cessation.Results: Overall, 8.1% of ever-smokers in underdeveloped areas of Indonesia had stopped smoking cigarettes at the time of the survey. Increased odds of smoking cessation were were observed among respondents living in urban areas (aOR=1.50, 95% CI: 1.13-2.00), females (aOR=2.59, 95% CI: 1.85-3.62), aged over 45 years (aOR=2.60, 95% CI: 2.13-3.17), the unemployed or students (aOR=1.60, 95% CI: 1.24-2.01), and heads of households (aOR=1.84, 95% CI: 1.45-2.32). Non-daily smokers (aOR=6.84, 95% CI: 5.68-8.24) and those who started smoking before age 18 (aOR=1.34, 95% CI: 1.10-1.62) were more likely to have quit smoking.Conclusion: Public health interventions should focus on supporting younger populations, informal workers, and daily smokers in rural areas to improve cessation rates.

Background: Opium consumption is a prevalent health concern in Iran, with conflicting evidence regarding its association with chronic conditions such as diabetes mellitus (DM) and hypertension (HTN).The present study aimed to investigate the association between opium consumption and the risk of diabetes mellitus (DM) and hypertension (HTN) among male participants aged 35–70 years in the Tabari Cohort Study (TCS).Study Design: A cross-sectional study.Methods: This study examined male participants from the TCS. Blood samples were collected after a 12-hour fasting period. HTN and DM were defined based on blood pressure (BP) measurements, history of diagnosis, and use of antihypertensive or glucose-lowering medications. The obtained data were analyzed using chi-squared and independent t-tests. A multivariate logistic regression analysis was used to adjust for potential confounders.Results: The study examined 4,149 male participants, with a mean fasting blood sugar (FBS) of 110.34±3 3.89 mg/dL, systolic BP of 115.70±13.60 mm Hg, and diastolic BP of 73.87±7.77 mm Hg. No significant difference was found in the frequency of HTN and DM among participants who consumed opium compared to those who did not consume it (P=0.588 and P=0.705, respectively). However, FBS levels were significantly higher among opium users (110.77±34.14 vs. 107.73±21.19, P=0.048). Multivariable regression analysis revealed no significant change in the risk of developing HTN (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82, 1.35, P=0.667) and DM (OR: 1.22, 95% CI: 1.57, P=0.116) among opium users.Conclusion: The findings of this study demonstrate no significant difference in the likelihood of developing DM and HTN between opium users and non-users.

Background: Road traffic accidents (RTAs) are a major cause of death, especially in developing countries. This study analyzed RTA patterns and trends in Hamadan province, Iran, from 2011 to 2024.Study Design: A cross-sectional study.Methods: Data on 6,488 road traffic fatalities, excluding non-road transport deaths, were obtained from the Forensic Medicine Organization. Demographics, injury type, location, and mode of transport were analyzed. Then, spatial clustering was performed using the K-prototype algorithm, with cluster quality assessed via the Silhouette Score. Finally, mortality trends were forecasted using the Prophet model with 95% prediction intervals and evaluated using RMSE, MAE, MASE, and MAPE.Results: The mean age of victims was 49 ± 21 years, with most deaths observed in the 15–44 age group. Most victims were male (75%), urban residents (60%), married (69%), and had not completed secondary education (41%). Fatalities mainly occurred at the scene (48%) or en route to the hospital (43%), with head/face injuries and hemorrhage as the leading causes. Spatial analysis revealed three clusters, with Famenin having the highest mortality (73.7 per 100,000). Mortality was projected to decline from 18.27 (16.01, 20.55) in 2025 to 9.57 (7.37, 11.69) in 2028, rising slightly to 13.94 (11.83, 16.17) in 2029.Conclusion: Overall, the findings emphasize the need for targeted regional interventions (e.g., road safety education, enhanced emergency services, and infrastructure upgrades) to reduce RTA mortality in the high-risk areas of Hamedan Province.

Background: Health literacy includes cognitive and social skills that enable individuals to understand and use health information effectively. In addition, it significantly influences health outcomes in society. Women with gestational diabetes mellitus (GDM) often have low health literacy and need better education. Therefore, this study explored the link between health literacy and general health in these women.Study Design: A cross-sectional study.Methods: This study involved 200 women with GDM referred to the Diabetes Clinic in Hamadan, Iran. The participants were selected through consecutive sampling, and the required data were collected using self-reported questionnaires, a health literacy questionnaire, and a general health questionnaire. The obtained data were analyzed using SPSS with a 95% confidence level.Results: The mean age of women was 29.63 years, and the mean±standard deviation (SD) of health literacy score was 77.41±16.44. Further, the mean±SD of the general health questionnaire score was 21.02±6.01. There was a positive correlation between health literacy and general health (P<0.001), as well as between health literacy and education (P<0.05). Moreover, a positive correlation was found between general health and education (P<0.05). Eventually, a significant negative correlation was observed between age and general health (P<0.05).Conclusion: Health literacy plays an essential role in managing GD and promoting general health for pregnant women. This subsequently leads to reduced postpartum complications for the mother and baby, as well as reduced healthcare costs.

Background: Despite long-standing efforts to improve water, sanitation, and hygiene (WASH) infrastructure in Indonesia, childhood diarrhea remains a pressing public health concern. This study focuses on the gaps between infrastructure and health equity by examining the intertwined effects of child, household, and environmental factors on the risk of diarrhea. Study Design: A cross-sectional study.Methods: In this study, data from the 2017 Indonesia Demographic and Health Survey (IDHS) were analysed using a multilevel logistic regression model. The survey included 16632 children, with children nested within households and households within a cluster (environment). All child, household, and environmental-level variables were included as fixed effects. Cross-level interactions were examined with sanitation, maternal education, and household wealth in terms of the prevalence of diarrhea.Results: Children aged 12–23 months (AOR=4.24; 95% CI: 3.23, 5.43), those with low birth weight [AOR=1.33 (95% CI: 1.04-1.70)], and those born to mothers with low education (AOR=1.74; 95% CI: 1.25, 2.44) had significantly higher odds of experiencing diarrhea. A significant interaction revealed that the impact of poor sanitation on children with less-educated mothers (AOR=1.68; 95% CI: 1.19, 2.37) and among educated mothers in children from low-income households (AOR=1.6; 95% CI: 1.12, 2.29) remained elevated. Children in non-Java-Bali regions also had persistently higher rates of diarrhea.Conclusion: Access to sanitation is insufficient to guarantee health equity. Maternal education plays a crucial moderating role in translating infrastructure into better health outcomes. To accomplish Sustainable Development Goals 6 and 10, integrated equity-focused sanitation programs, including poverty reduction and maternal empowerment, are of great importance.

Background: Anxiety and depression are major public health concerns due to their high prevalence and associated suffering, dysfunction, and socioeconomic impact, particularly among young individuals. Identifying factors associated with anxiety and depression is crucial for the prevention and promotion of mental health in youth. The present analysis aims to identify factors associated with anxiety and depression among youth, based on a youth health survey undertaken in Kolar district, India.Study Design: This study employed a cross-sectional design.Methods: A secondary data analysis was conducted using data from the Kolar Youth Health Survey, which collected data on various health-related behaviors and conditions from 5,072 youth (aged 15–30 years). Anxiety and depression were screened using standardized tools (GAD-7 and PHQ-9, respectively). Multivariable logistic regression was conducted to identify associated factors. The model’s goodness of fit was evaluated using the Hosmer-Lemeshow test and the area under the curve.Results: Socio-demographic characteristics (marital status, taluka, age), self-reported diagnosed health conditions, sleep issues, suicide and non-suicidal self-harm, tobacco dependence, time spent on phone/computer, family relationships (loving/affectionate relationships vs. serious conflicts), friendships, belief in God, and injury (physical violence, road traffic injuries) were significantly associated with anxiety and/or depression among youth in the study area.Conclusion: Selected sociodemographic characteristics, health-impacting behaviors, and health issues were found to be significantly associated with anxiety and/or depression among youth. Considering these risk factors will enable health care providers and policymakers to develop and implement tailored interventions.

Background: Individual alcohol consumption depends on living conditions at different territorial and environmental levels. This study examined the influence of regional living conditions on individual alcohol consumption based on the results of a large Russian nationwide study (2012-2022).Study Design: A cross-sectional multicenter observational study.Methods: Individual data from three stages of the Russian nationwide study, including the Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Regions of the Russian Federation (ESSE-RF1) (2012-2014), ESSE-RF2 (2017-2018), and ESSE-RF3 (2020-2022), were used for investigation. The study samples included 53,902 men and women aged 25–74 years from 31 regions. Individual data were combined with the annual values of four regional indices that characterize economic, demographic, social, and industrial environmental conditions. The analyzed outcomes included any alcohol consumption and binge drinking.Results: The industrial development of regions was associated with an increased likelihood of any alcohol consumption (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.59–1.72) and binge drinking (OR: 1.31, CI: 1.22–1.40). Improved economic (OR: 0.75, 95% CI: 0.72–0.78), demographic (OR: 0.73, 95% CI: 0.71–0.76), and social (OR: 0.55, 95% CI: 0.53–0.56) living conditions exhibited inverse associations with any alcohol consumption. Similar inverse associations of binge drinking were noted with the economic (OR: 0.84, 95% CI: 0.76–0.92), demographic (OR: 0.91, 95% CI: 0.85–0.98), and social (OR: 0.78, 95% CI: 0.73–0.82) indices.Conclusion: In general, our findings revealed the associations of alcohol consumption and binge drinking with the regional characteristics of living conditions.

Background: The present study was designed to assess the mortality rate and years of life lost due to suicide in Khuzestan province.Study Design: A cross-sectional study.Methods: In this study, data on all deaths caused by suicide in Khuzestan province were obtained from the population-based Electronic Death Registration System (EDRS). Crude and age-standardized suicide mortality rates (ASR) were calculated based on gender and year of death over the study period. Subsequently, the number of years of life lost (YLL) was calculated based on age and gender. Joinpoint regression analysis was used to examine the trends in crude mortality rates, age-standardized rates (ASRs), and YLL rates.Results: During the study years, 1904 suicide deaths occurred in Khuzestan province. Of these deaths, 1157 (60.8%) occurred in men. The highest number of deaths in both genders occurred due to hanging. According to the joinpoint regression, the 12-year trend of YLL rate due to premature mortality was stable. The average annual percentage change (AAPC) was -0.4% (95% CI -4.5 to 7.9, P=0.986) for males, and it was 2.4% (95% CI -1.6 to 7.5, P=0.222) for females. There were 1 joinpoint and 2 time periods for males (2012-2014 (non-significant decreases) and 2014-2023 (significant increases)), and there were 1 joinpoint and 2 time periods for females (2012-2016 (significant decreases) and 2016-2023 (significant increases)).Conclusion: The findings revealed a significant increase in age-standardized mortality rate among women and a stable trend among men, and a slight rise in crude mortality rate in men. To address these concerns, it is recommended that targeted region-specific prevention programs be strengthened.

Background: The urban poor represent a vulnerable population within society, particularly in terms of maternal health. Economic and access-related limitations often prevent this group from accessing healthcare services, especially in the institutional delivery process. This study aimed to analyze the barriers to institutional delivery among Indonesia’s poor urban society.Study Design: This study employed a cross-sectional design.Methods: Data were obtained from the 2023 Indonesian Health Survey, including 7,548 participants. Eight independent variables were analyzed, including age, education, marital status, employment, wealth, insurance, and parity, with institutional delivery used as the dependent variable. Binary logistic regression was employed for analysis. Results: Approximately 38.1% of Indonesian pregnant women had non-institutional deliveries. All age groups showed a higher likelihood of non-institutional delivery compared to those aged≥45. Lower education levels were associated with a heightened probability of choosing non-institutional delivery. Married women were 0.704 times less likely than divorced or widowed women to give birth in non-institutional settings (AOR: 0.704; 95% CI: 0.693-0.716). Unemployed women had 1.218 times higher likelihood of engaging in non-institutional delivery compared to employed women (AOR: 1.218; 95% CI: 1.1210-1.226). The poorest women were 0.973 times less likely than the poorer group to have non-institutional delivery (AOR: 0.973; 95% CI: 0.967-0.980). Uninsured women were 2.364 times more likely than insured women to give birth outside of healthcare institutions(AOR: 2.364; 95% CI: 2.345-2.379). Women with all other parity levels were less likely than grand multiparous women to have non-institutional deliveries.Conclusion: Seven barrier factors to institutional delivery were younger age, low education, divorced/widowed marital status, unemployment, lower wealth status, lack of insurance, and grand multiparity.

Background: The trend of human immunodeficiency virus (HIV) disease progress is different for every patient. Some patients may experience events during the course of their disease that can affect disease progression and death. The main objective of the present study was to investigate the effect of risk factors in progression of HIV disease, taking into account intermediate events, using a multistate model.Study Design: A retrospective cohort study. Methods: The current study used information from 673 HIV-infected adult patients registered at the Hamadan Provincial Health Center in Iran, between 1997 and 2023. A multistate framework was described to investigate the progression of HIV disease over time. Three states (HIV-infected, acquired immunodeficiency syndrome [AIDS], and death) and three possible transitions (from HIV to AIDS, from HIV to death, and from AIDS to death) were considered in this framework. An illness-death multistate model was applied to determine the effect of risk factors on these transitions. Results: The results revealed that receiving antiretroviral therapy (ART) significantly decreased the hazard of transition from HIV to AIDS, whereas older age, tuberculosis (TB) co-infection, and treatment with the final guideline intensified the hazard of the mentioned transition. Low education, older age, and unprotected sexual transmission increased the risk of transition from HIV to death, while receiving ART and treatment with the final guideline decreased the risk of this transition. Receiving ART, being employed, having a history of prison, and being treated with the final guideline could decrease the hazard of transition from AIDS to death, whereas TB co-infection increased the hazard of this transition.Conclusion: Implementing strategies for early diagnosis, timely treatment, adherence to treatment, as well as screening and TB treatment, especially at younger ages, can be useful in reducing AIDS progression and mortality.